Background/Purpose:

Secukinumab, an anti-interleukin 17A monoclonal antibody, showed significant improvement of signs and symptoms of psoriatic arthritis (PsA) in phase 3 studies. Available studies used conventional radiography, not allowing a deeper imaging analysis of the inflammatory changes during application. The aim of this study was to assess short term efficacy of secukinumab on inflammation and structural damage according to change in OMERACT-EULAR ultrasound score, the MRI PsAMRIS score, and HRpQCT scans of the MCP and PIP joints in PsA patients.

Methods:

PsA patients with active disease (TJC and SJC ≥ 3), were included in the 24 week open label prospective PSARTROS study and treated with subcutaneous secukinumab 300 mg once weekly over 4 weeks, then once every 4 weeks. Baseline 1,5T MRI hand scans, HRpQCT scans of the MCP and PIP joints, and ultrasound imaging of 28 joints were performed at baseline and after 24 weeks of treatment. MRI was scored according to PsAMRIS. HRpQCT scans were evaluated for erosions and osteo-proliferation. Ultrasound was assessed for synovial hypertrophy and Doppler activity according to OMERACT scores. Statistical significance was set at p≤0.05.

Results: 20 patients, mean age 52 ± 9.9 years, 60% female, mean disease duration 6.7 ± 5.9 years, 50% naive for biological therapy, were included in the study. Three patients were early discontinued (recurrent pharyngitis, lack of efficacy, withdrawal of consent), and were not included into the longitudinal analysis. Baseline DAS28 was 5.03±0.96, baseline DAPSA was 32.2±12. 1. On baseline MRI, all patients had at least one inflammatory sign (synovitis: 90%, osteitis: 20%, periarticular inflammation: 25%, flexor tenosynovitis: 35%, bone proliferation: 30%, erosions: 60%). Baseline composite PsAMRIS score was 11.6±12.8 and baseline PsAMRIS synovitis score was 3.7±3.3. Baseline ultrasound synovial hypertrophy and Doppler activity were 6.2±4.5 and 3.5±4.0, respectively. Specific MRI and ultrasound scores were significantly correlated with DAS28 and DAPSA at baseline. Clinical disease activity parameters significantly improved at follow up (DAS28: 2.94±0.95, p<0.001; DAPSA: 8.8±5.8, p<0.001). PsAMRIS synovitis score (2.5±2.4) as well as composite PsAMRIS score (8.8±10.0) decreased longitudinally with secukinumab treatment (p=0.034 and p=0.039, respectively). There was no progression in erosion or proliferation scores between baseline and follow-up through MRI and HRpQCT imaging. Synovial hypertrophy and Doppler activity in ultrasound also significantly improved with secukinumab treatment (2.3±3.5; p=0.009 and 1.8±2.7; p=0.003, respectively). A significant percentage of patients reaching minimal disease activity showed residual signs of synovitis in the MRI and US (66% and 50%, respectively).

Conclusion:

Secukinumab significantly improves MRI and ultrasound signs of joint inflammation in patients with PsA. No progression in articular damage or osteo-proliferation was observed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-of-joint-inflammation-as-assessed-by-mri-and-power-doppler-ultrasound-pdus-in-an-open-label-study-in-patients-with-active-psoriatic-arthritis/